How Does Moral Distress Impact Nursing Career?

Moral dilemmas, decisions, and distress are the three “Ds” in nursing that require resilience and courage to overcome. Distress is normal in life, though it is something none of us want and everyone tries to avoid.

Usually, the cause of physical and emotional pain can upset and disrupt our lives. Distress can develop for various reasons, such as financial problems, work situations and family issues. Everyone has experienced distress at one time or another in their lives.

Distress is usually emotional and causes you to feel overwhelmed, nervous, anxious, and even afraid. Physical distress can cause GI upsets, headaches, respiratory problems, and more. If you are a practicing nurse, the distress can have severe consequences if left unaddressed.

According to the nature of our work, we often find ourselves in situations that others may have never experienced. Patient care problems, such as informed consent, end-of-life decisions, and advanced directives can cause it.

It can also develop due to staff or workplace issues caused by communication gaps, accidents, errors, and poor decisions.

All these issues are part and parcel of nursing and can quickly become a moral dilemma for most nurses. The decisions that some situations call for can enhance the distress level and often cause moral distress.

What is Moral Distress? How to deal with Moral Distress?

How Does Moral Distress Impact Nursing Career

How to deal with Moral Distress?

Moral distress has been a point of interest and research in the healthcare industry for over 30 years. Many professionals wonder if they are experiencing moral distress, what it feels like and how it happens.

Researching moral distress is one thing, but dealing with it requires a deeper understanding of what moral distress is. Studies have shown a direct link between the dilemma and the decisions you deal with. The inner struggle between dilemma and decision can cause moral distress to develop.

According to Andrew Jameton, moral distress occurs when a nurse knows the right thing to do, but institutional constraints prevent them from taking the appropriate action. This usually happens when a nurse believes they know the right thing to do but feels helpless or afraid to do so.

As many patient care situations can be serious, some see moral distress as an expected part of being a professional nurse and as something to be accepted.

In short, moral distress is caused when you can’t accept being asked to do something you believe to be morally and ethically wrong. In contrast, the organization’s rules and regulations of the superiors do not think so.

This is where moral courage is practical.

What Is Moral Courage?

Moral courage has the conviction and courage to stand up for your beliefs. It is not always easy to show moral courage, even if you are grown up. Most people believe they have strong moral courage even though they have not experienced moral distress. Enough moral courage enables you to challenge and speak up against unacceptable policies and practices, though it does not always happen.

Taking a stand against morally distressing situations is quite difficult but not impossible. Speaking up against an amoral or unethical order may only help a little, though it may not relieve the moral distress you are experiencing. It takes practice to have moral courage and to display it when needed.

According to research by the American Nurses Association, even the most morally courageous staff may have a fear of speaking up.

How Does Resilience Help Beat Moral Distress?

Resilience is commonly heard in discussions on moral distress. According to studies, moral resilience is the ability to handle diverse ethical situations without suffering the lasting effects of moral distress. This requires morally courageous action, support, and doing the right thing.

So, the question arises: How can a nurse effectively address moral distress?

The American Nurses Association (ANA) offers guidance on developing moral resilience and addressing moral distress, though the specific number and nature of recommendations can vary and evolve. These are:

  1. Adopting ANA’s Healthy Nurse Healthy Nation strategies. This helps to support your overall well-being as a foundation for developing moral resilience.
  2. Read, review, and implement the ANA Code of Ethics for Nurses, with interpretive statements, to gain the right knowledge to strengthen ethical competence.
  3. Seeking opportunities to learn to recognize, analyze and take ethically grounded action to respond to ethical complexity, conflict, or disagreement.
  4. Cultivating self-awareness to identify and respond to symptoms of moral distress and moral suffering in general.
  5. Pursuing educational opportunities that help to develop mindfulness, moral resilience, and ethical competence.
  6. Develop your plan to support overall well-being and ensure improved moral resilience.
  7. Becoming involved and initiating workplace efforts to remedy the root cause of moral distress or other types of moral suffering.
  8. Developing and practicing skills in mindfulness, communication, inter-professional collaboration and conflict transformation
  9. Recognizing and using personal resources within your organization and community (like peer-to-peer support, ethics committee, counseling, etc.) under employee assistance programs.


Moral distress is a common experience for practicing nurses, irrespective of their field of specialty. This problem can be remedied with moral courage and resilience.

You need to recognize the signs and causes of your moral distress to find the courage and resilience to overcome it and not let it affect your responsibilities and professional performance in a healthcare setting.

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